Donation Pickup Dev - Rubbish Doctor

Extra Large item *

Price: $34.99

2+ person lift / special equipment

Large item *

Price: $24.99

2-person lift

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Number

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Number

Medium item *

Price: $9.99

1-person lift

Small Item *

Price: $7.99

1-person lift

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Number

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Number

Staircases*

If no elevator

Elevator*

Disassembly *

Price: $29.99

Disassembly

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Number

Address*

Street Address Address Line 2 City State ZIP Code

Preferred Date*

Preferred Time*

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Name*

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Phone*

Email*

Additional Details*

Driver Instructions*

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Order Summary

Item	Description	Qty	Unit Price	Line Total
Extra Large Item	2+ person lift / special equipment	{Extra Large Item:34.3}	$34.99	{Extra Large Total:101}
Large Item	2-person lift	{Large Item:3.3}	$24.99	{Large Total:102}
Medium Item	1-person lift	{Medium Item:6.3}	$9.99	{Medium Total:103}
Small Item	1-person lift	{Small Item:5.3}	$7.99	{Small Total:104}
Staircases	If no elevator	{Staircases:7.3}	$19.99	{Stair Total:105}
Disassembly	Requiring tooling / upcharge items	{Disassembly:8.3}	$29.99	{Disassembly Total:106}

Base Price*

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Fuel Fee*

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